大出血を来し画像的に異所性胃粘膜と潰瘍を描出しえたMeckel憩室の1例

Bleeding Meckel's Diverticulum with Ectopic Gastric Mucosa and Ulcer Diagnosed by Double Contrast X-ray Examination of the Small Intestine, Report of a Case

要旨　患者は34歳，男性．1990年11月，下血を主訴に近医で合計3,000mlの輸血を受けた．上部・下部消化管精密検査にて異常所見を認めず，出血源が不明のため当センターに紹介された．下部消化管造影検査では出血源は不明で経過観察となった．1991年9月，頻回の下血があり，近医で合計1,000mlの輸血を受け，10月に再度，当センターを紹介され，小腸造影検査が施行された．小腸造影検査では回盲弁から約50cm口側の回腸に8×2cmの憩室を認めた．憩室の粘膜に胃小区模様と潰瘍が描出され，Meckel憩室からの出血と診断した．同年11月21日，血圧低下を伴う大量の下血があり，緊急手術として憩室切除術（楔状切除）が施行された．切除標本の組織学的検索では，各層の欠如のない真性憩室で，異所性胃粘膜と回腸粘膜にUl-Ⅲの潰瘍を認めた．小腸造影検査で術前に異所性胃粘膜と潰瘍が描出されたMeckel憩室の1例を報告した．

　A 34-year-old male visited another hospital with a complaint of melena. Gasrtrofiberscopy and barium enema were performed, but the source of gastrointestinal bleeding was not discovered. Then he visited our hospital twice. At first we could not find the source of bleeding by barium enema. At the second time x-ray examination of the small intestine was performed, a revealing a diverticulum with gastric area pattern and ulcer. We diagnosed it as Meckel's diverticulum.

　Wedge resection of Meckel's diverticulum was performed, and macroscopically the resected material showed granular mucosa and ulcer. Microscopically it proved to be a true diverticulum, and consisted of ectopic gastric mucosa and ileum mucosa. Fibrosis due to ulcer had reached to the proper muscle layer.

　We thus diagnosed a bleeding Meckel's diverticulum with ectopic gastric mucosa and ulcer by double contrast radiograph of the small intestine.